Reporting of the circumferential tumour margin involvement and preoperative levels of carcinoembryonic antigen as prognostic risk factors in colorectal cancer patients

Background and study aims: The two very important prognostic risk factors of colorectal cancer are circumferential tumour margin [CTM] involvement and preoperative levels of carcinoembryonic antigen [CEA]. The aim of this study is to monitor the frequency of reporting of the CTM in the postoperative pathology reports after colorectal cancer resection in addition to monitoring the frequency of reporting of preoperative levels of CEA and exploring the possibility of improving the frequency of reporting of both

Patients and methods: Reports of the CTM and preoperative level of CEA were found in 730 [664 retrospective and 66 prospective] patients with colorectal cancer. The possibility of improving the incidence of reporting was estimated by comparing the reporting frequency of both [retrospective and prospective] groups

Results: The percentage of reporting the involvement of the CTM was 46.08% and 81.81% for the retrospective group and the prospective group, respectively. The percentage of reporting the preoperative CEA levels was 40.9% and 68.7% for the retrospective and the prospective groups, respectively. There was a statistically significant difference in reporting both CTMs and the preoperative level of CEA between retrospective and prospective groups to the side of prospective group in which the p-value was <0.0001 for both groups

Conclusion: There was inadequate reporting of both the CTM involvement and preoperative levels of CEA in the retrospective patients with statistically significant improvement of this reporting in patients in the prospective group. This may point to the unawareness of the importance of both in the prognosis of colorectal cancer, which may be because both are not involved in the widely used tumour, node, metastasis [TNM] staging system

Efficacy of oral fluconazole in the treatment of cancer patients with oropharyngeal candidiasis

The present prospective non comparative study included 30 evaluable cancer patients with oropharyngeal candidiasis treated in NEMROCK. All patients received either systemic chemotherapy [81%] or oropharyngeal radiation therapy [19%]. The majority of cases [81%] were enrolled after [culture proven failure] other antifungal agents used to control oropharyngeal candidiasis. All patients were treated by oral fluconazole and an initial dose of 50-100 mg/day for a median period of 12 days [range 7-28 days]. Side effects were generally mild including nausea, abdominal pains and heart burn being observed in 5 patients with none of them needing dose reduction of fluconazole. Complete cure was achieved in 80% of the patients and mycologic eradication was documented in 60%, whereas reinfection was seen in 10%

Malignant mesothelioma: Epidemiology - diagnosis and treatment results of 46 cases

This retrospective study included 46 cases of pathologically proven malignant mesothelioma referred to NEMROCK during the period 1978-1989 inclusive. There was a significant progressive increase in the relative frequency of the disease throughout the study. The median age of the patients [39 years] was strikingly younger than the westerns. Asbestosis was encountered in 50% of the cases. Chest pain and dyspnea were the most frequently encountered symptoms, while constitutional symptoms were seen in 41%. Epithelial subtype was the commonest histopathologic variant [43%]. Only 22% of the cases were diagnosed by one pathological sample while 24% needed more than 3 pathological samples to confirm the diagnosis. The diagnostic accuracy was modest for fluid cytology [21%] and blind needle biopsy while satisfactory results were obtained by C.T. guided biopsy [64%] and thoracotomy [86%]. Ipsilateral volume loss with nodular pleural thickening [predominently basal] were the most common radiological features. C.T. Scan was superior to plain chest films in detecting minimal effusion, pericardial involvement and mediastinal disease. None of the treated patients achieved complete remission by treatment. The response rate was 17% for radiotherapy [12 cases] and 25% for the combination of ifosfamide and adriamycin [20 cases], with a median survival of 14 months and 11 months respectively. By multivariate analysis old age, late stages and bad performance status were significantly associated with poor survival

Treatment of metastatic colorectal carcinoma with 5-fluorouracil and folinic acid: a pilot study

Twenty four evaluable patients with metastatic colorectal carcinoma were entered into a pilot study that used 3 consecutive days of 5- fluorouracil [600 mg/m2 as 24 hours infusion] and folinic acid [120 mg/m2 as 4 hours infusion]. This regimen was repeated on 3 weekly basis. Eight patients [33%] were considered to be refractory to previous fluorouracil monotherapy. Objective response [including one complete remission] was seen in 33% of the patients. Two out of the 8 previously treated patients [25%] exhibited partial remission. The mean survival time was 13.5 months for responders 8.5 months for stable disease and 3.8 months for progressive disease [P less than 0.01]. Treatment related toxicity was generally mild with no single life threatening complication. Diarrhea and oral mucositis were the 2 most commonly encountered adverse effects

Locally advanced breast cancer: a problem for a combined approach

One hundred sixty seven evaluable cases with non-inflammatory locally advanced breast cancer [Stage III b] were retrospectively studied for the results of treatment, pattern of relapse and survival at a follow up period of 2 years. The patients were collected at Kasr Elaini centre of Radiation Oncology and Nuclear Medicine over a period of 9 years [1979-1987]. The patients were managed by different single and combined treatment modalities [Non protocol]. At 2 years, patients treated by locoregional treatment approaches [Surgery and/or radiotherapy] had a very poor relapse free survival [23%] which improved to 41% when 6-9 courses of chemotherapy were added after locorgional treatment [P<0.05]. best relapse free survival [59%] was obtained when intial [Neoadjuvant] chemotherapy [adriamycin based regimen] was used prior to surgery and radiotherapy. When radiotherapy was used to control the primary disease; doses above 65 Gy could achieve 78% local control at 2 years versus 30% in doses below 60 Gy [P< 0.05]. The role of surgery and its timing as well as extent were discussed concluding that prior chemotherapy was of great benefit